Bahati Sanga arrived at Iringa Regional Hospital with his teenage twin sons. He had noticed a poster in the market advertising free male circumcision (MC) services at the hospital clinic. Bahati had been waiting for just such an opportunity. As he had learned from his father, the consequences of not acting to protect his sons from HIV could be serious.
“Myself and all of my brothers were circumcised. Our father told us that being circumcised was good for our health, it was hygienic, and it helped us to avoid sexually transmitted infections,” said Bahati, 42, who sells fish at the local market to support his wife and eight children.
“Men need to be more involved in the health of their families,” he adds, enthusiastically.
For the past year, Jhpiego’s Tanzania team has been working closely with the Ministry of Health and Social Welfare, through the regional hospital, to establish MC services in the Iringa region. With the highest prevalence of HIV in Tanzania (15.7%) and only 29.1% of men circumcised, Iringa stands to benefit tremendously from an expansion of such services. Beginning in September 2009, with assistance from Jhpiego, Iringa hospital has been offering free MC services for all men and boys, 10 and above. Since that time, more than 1,500 have participated. Men who are circumcised are about 60% less likely to be infected during heterosexual sex than men who are not circumcised.
In addition to the surgical procedure, MC services for HIV prevention include group and individual counseling on the circumcision procedure and other HIV and male reproductive health issues, and HIV testing for those who are willing.
Bahati, who lives in a village on the outskirts of Iringa, wanted his sons to be circumcised, as he had been when he was eight years old.
But prior to Jhpiego’s work with Iringa hospital, it was difficult to access MC services. Bahati considered taking his sons to a traditional circumciser, but this was both expensive (about $15) and risky, given that infections are common and traditional circumcisers in the area do not provide any aftercare services. And when men and boys who suffer complications do seek help from health professionals, they often face discrimination from providers who do not approve of the traditional practice.
Isaac also remembers the March visit to the clinic: “We were so happy that our father took us, because we would have been shy if we were taken by our mother. It is good for fathers to take their sons for circumcision.”Iluminata Sanga, nurse in-charge for the circumcision clinic at Iringa Regional Hospital, says that most boys come for circumcision services with their mothers, but that it is important for fathers to be more involved.
“Many times, we find that the fathers of the boys who come for circumcision are not, themselves, circumcised,” says Iluminata. “Maybe they don’t bring their sons because they are afraid of having the procedure, but it is important for them to come.”
The nurse recalls one father who came with his son to the hospital and both were circumcised on the same day.
Bahati believes that all men should be circumcised to reduce the spread of sexually transmitted infections, including HIV, and he plans to bring his two youngest sons, ages six and eight, when they are old enough. But there are barriers to preventing HIV in the community. Bahati says that his pastor at church forbids the use of condoms, instead encouraging husbands and wives to be faithful to their spouse.
Bahati says he would like to see more people in his village learn about MC through community activities and the type of posters that first alerted him to the free services at Iringa Regional Hospital. “Men need to go with women and children to clinic visits so that the messages that the women are getting can also be shared with the men, so that we can also be educated!”
So Bahati was very happy when he learned about the free services being offered at the regional hospital. Twins Niko and Isaac, 15, were both willing to be circumcised. “We saw that our friends had been circumcised, and we wanted to look like them,” said Niko. “We also knew that circumcision would help to protect us from HIV and other diseases.”